Mental health is a severe health topic that requires the attention of the president of the United States of America. Mental health needs to be at the top of the presidential agenda so that policies and resources can be made to help serve those Americans who have mental illness and mental health issues. 

Social determinants affecting mental health are access to care, poverty, transportation, geographical location, educational level, and ethical and cultural backgrounds. According to Whealin et al. (2017), telehealth treatment for veterans facing mental health issues can alleviate the social determinants of rural area locations and veterans with diverse backgrounds or cultures. Rural areas are associated with higher suicide rates (Tarlow et al., 2019). Rural areas are underserved, and most live below the poverty line. Rural areas have low socioeconomic status, which gives way to underserved medical care, primarily mental health care (Tarlow et al., 2019).

The past two administrations have made great strides to improve mental health and work toward awareness, prevention, treatment, and wellness. 

The Trump administration can be credited for the majority of these improvements. The Biden Administration has continued with these improvements and made more funding available. 

As noted by Satel & Torrey (2021), President Trump appointed the first psychiatrist for the positions of the assistant secretary for mental health and substance use and the director of the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA is a federal agency that facilitates federal mental health policy. Dr. Elinore McCance-Katz is known for many improvements to SAMHSA by focusing on the agency’s priorities and treating mental illness (Satel & Torrey, 2021). On October 3, 2020, President Trump signed Executive Order 13954, “Saving Lives Through Increased Support for Mental and Behavioral Needs.” Light of the Coronavirus pandemic caused many to face stress, loss of jobs, and social isolation (The White House, October 5, 2020). These factors increased the number of Americans’ facing mental and behavioral health issues due to the negative impact of shutdowns. Trump also signed into law a designated 9-8-8 hotline for suicide prevention and mental health crisis (States News Services, October 19, 2020). 

The Biden Administration, on March 12, 2021, announced that SAMHSA would be providing $2.5 billion to help the states with addressing continuing mental health and addiction crises through grant programs (State News Service, March 12, 2021). Biden Administration also has sourced millions in funding through grants for community behavioral health centers. The grant funding will come from the Bipartisan Safer Communities Act (Gonzalez & Harris, 2022). The Biden Administration has provided $4 billion for the American Rescue Plan (ARP) and made the connection to care more accessible along with a continuum of care and support for Americans’ facing mental health or substance abuse factors (The White House, May 31, 2022). 

One thing I would do differently is to focus on access to telehealth care for rural areas. I would make funding available to provide the equipment and services to provide telehealth care via the person’s home setting.

References:

Gonzalez, A., & Harris, E., (October 18, 2022). Biden administration announces millions in

Funding for community behavioral health center.

https://www.nyl.com/nyc/all-boroughs/politics/2022/10/18/biden-administrationLinks to an external site.

Satel, S. & Torrey, E. F. (February 01, 2021). Don’t undo Trump Administration’s mental-

health reforms. American Enterprise Institute,

https://www.aei.org/articles/don’t-undo-the-trump-administartions-mental-health-reform/Links to an external site.

States News Services, (March 12, 2021). Trone Hails Biden Administration’s $2.5

Billion investment in mental health and addiction services. Gale,

https://go.gale.com/ps/i.do?=EAIM&u=minn4020&v=2.1&it=r&i/A654735553Links to an external site.

State News Service, (October 19, 2020). Trump signs Reed’s Bipartisan plan to adopt national

9-8-8 suicide and mental health crisis hotline into law. Gale,

https://go.gale.com/ps/i.do?p=Eaim&u=minn4020&id=GaleA6338890961Links to an external site.

Tarlow, K. R., Johnson, T. A., McCord, C. E. (2019). Rural status, suicide ideation, and

Telemental health: Risk assessment in clinical sample. The Journal of Rural Health, 35,

247-252. https://doi.org/10.111/jrh.12310Links to an external site.

The Whitehouse.  (May 31, 2022). Fact Sheet: Biden-Harris Administration highlights strategy    to address the national mental health crisis. The White House,

https:www.whitehouse.gov/briefing-room/statement-release/2022/

The Whitehouse. (October 5, 2020). President Donald J. Trump is safeguarding Americans’ https://doi.org/10.1177/0091217417703291Links to an external site.

Whealin, J. M., King, L., & Spira, JL., (January 2017). Diverse veterans’ pre- and post-

intervention perceptions of home telemental health for posttraumatic stress disorder

delivered via tablet. The International Journal of Psychiatry in Medicine, 52, 3-20,

            https://doi.org/10.1177/0091217417703291Links to an external site.

My topic of interest is childhood obesity. Childhood obesity is a national problem that carries the risks of potential co-morbidities and increased risk of chronic diseases. In the United States alone, the prevalence has tripled in the last thirty years and at present, more than 30% of American children are overweight or obese. (Vash, P.D. 2015).

The cause of the increased rates of childhood obesity is complex and multifactorial and must be addressed on different levels. (Sommer, A., Twig, G. 2018). One of the most obvious problems is to change the messages our children received about food (Casazza, K.R.& Hanks, L.J., 2015).

One of my observations as I traveled to Paris, France last year, where obesity is one of the lowest in the world for both children and adults was, I barely see any soda bottles lining the store shelves including the hallways of the airport. According to the Journal of American Dietetic Association, 70% of Americans consumed more than 1 glass of sweetened beverage per day which is linked to obesity (ncbi.nlm.nih.gov).

Given that big corporations are unlikely to readily change their advertising practices about food, the government needs to get involved. (Vash, P.D. 2015).  One example was the project of then-former first lady Michelle Obama in 2010 who introduced the “Let’s Move” movement which emphasized solving childhood obesity problems on a different level, from educating parents to schools to communities.

As practicing nurses with always have a goal to help and have a responsibility to be an advocate for our patients and their families, it is very difficult to witness when the patient is unable to access what they need. With a problematic healthcare system, we nurses are dealing with serious healthcare disparity in the communities we serve. (Abood, S. 2007). Through this learning and discussions, I hope to learn and be able to be proactively influenced my patient and their families and colleagues to bring about change in the community I served.

References:

Vash, P. D. (Ed.). (2015). The childhood obesity epidemic : Why are our children obese-and what can we do about it?. Apple Academic Press, Incorporated.

Casazza, K. R., & Hanks, L. J. (Eds.). (2014). Clinical insights : Obesity and childhood. Future Medicine Ltd.

Abood, S. (January 31, 2007). “Influencing Health Care in the Legislative Arena”. OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1, Manuscript 2. from https://doi.org/10.3912/OJIN.Vol12No01Man02Links to an external site.Links to an external site.

Sommer, A., & Twig, G. (2018). The Impact of Childhood and Adolescent Obesity on Cardiovascular Risk in Adulthood: a Systematic Review. Current Diabetes Reports, 18(10), 1-6. https://doi.org/10.1007/s11892-018-1062-9

Income as a Social Determinant of Mental Health

Numerous studies have established a high incidence of mental disorders in poor and disadvantaged communities all over the world. The social determinants of health act reflexively upon one another such that an effect such as poor mental health can hardly be attributed to only one factor. Poverty results from low incomes, and low incomes result from a wide array of other factors, for instance, racial discrimination, poor education, and unemployment. Notably, this part of the discussion looks only into low income as the most impactful social determinant of mental health.

Income level is crucial to individual and group health outcomes. Low incomes have been associated with premature mortality, life expectancy, and mortality rates in physical health. Low incomes impact mental health by contributing to poor mental health, increased incidence and risk for mental disorders and substance abuse, and worsening outcomes for those already affected by substance use disorders and mental illnesses. Katz-Wise et al (2017) found that low income is related to the higher incidence of suicide attempts, self-harm, and depression in transgender adults. Low income has also been linked to increased anxiety and depression among pregnant women, a condition that elevates the risk for neonates. Compton & Shim (2015) suggest that low incomes are associated with more mentally unhealthy days, a higher risk of death from a drug overdose, and poor child well-being scores.

Trump and Biden Administration response to mental illness

Interventions to healthcare issues can be clinical-level or policy-level interventions. While clinical interventions are applicable for individuals, lasting population-wide effects can only be achieved through policy action at the state and federal levels. President Trump held stewardship of the country at a time of healthcare crisis, where COVID-19 was running rife, and people had to adapt to a new way of life. The losses and uncertainties of this period resulted in aggravated mental health with 40% of adults showing symptoms of mental health disorders. President Trump signed Executive Order 13594 on October 5, 2020, creating a Coronavirus Mental Health Working Group to evaluate existing federal mental health programs and mitigate the negative effects of COVID-19 on mental health (Knopf, 2020). Another action by the Trump administration was to increase funding for suicide prevention by $50 through the CARES Act.

One of President Biden’s actions to tackle mental illness is approving funding for the launch of the 988 mental health crisis hotlines for emergency care. The $180 million from the Biden administration goes to staffing crisis call centers and local response teams. In addition, the Biden administration has invested approximately $4 billion in expanding access to mental health and substance use services through the American Rescue Plan; issued an advisory on healthcare worker burnout; and expanded provider training via Nurse Corps, AmeriCorps, and community behavioral facilities (Smith & Sisti, 2022).

Criticism and Concluding Thoughts

Even though the Trump administration increased funding for suicide prevention programs, this was directed to veterans and not to the mass of Americans undergoing mental health crises. Also, Executive Order 13594 was largely an academic exercise where concrete action was required. More effective action would be directing additional funding to training counselors and increasing access to mental healthcare providers for millions of Americans in poor mental health. Even though veterans are a vulnerable group, other similarly vulnerable groups did not receive suicide prevention assistance. The Biden administration is commendable in its response to mental health disorders as demonstrated by increased funding for mental health, improved access to care, the crisis hotline pilot test, and the expansion of provider networks. My Change would create more community centers for underserved populations and open more counseling centers.

References

Compton, M. T., & Shim, R. S. (2015). The social determinants of mental health. Focus, 13(4),

419-425.

Katz-Wise, S. L., Reisner, S. L., White Hughto, J. M., & Budge, S. L. (2017). Self-reported

changes in attractions and social determinants of mental health in transgender adults. Archives of Sexual Behavior, 46(5), 1425-1439.

Knopf, A. (2020). The transition of the federal government: The path forward for SAMHSA. Alcoholism

& Drug Abuse Weekly, 32(44), 1-5.

Smith, W. R., & Sisti, D. A. (2022). Rapprochement and reform: overcoming factionalism in

policymaking for serious mental illness. Psychiatric Services, 73(5), 539-546.

Main Question Post

During his campaign, President Donald Trump had a platform to fight drug addiction. He planned to build a wall on the US-Mexican border to stop illegal drugs from coming into the country. Ultimately, by the end of his four years in office, 80 miles of the wall had been built. Short of covering the nearly 1,200-mile Texas and Mexico border, according to Garcia and Cai (2016). Trump’s Vice President, Mike Pence, acknowledged that drugs were mainly coming into the US through ports of entry (Gomez, 2019) and not the border.

Converse to Trump, Biden’s platform was not building a wall but holding big pharmaceuticals responsible and directing services to support people with substance use disorders. Biden also identified the need to stop smuggling from Mexico and China, according to Joe Biden for President: Official Campaign Website (2020). In comparing funding to support their drug policies, Trump’s first budget requested 27.8 billion Souza (2017). In 2022, Biden’s budget asked 41 billion Cunningham (2022).

What would I do differently? Good question. Recognizing the checks and balances in place with the different branches of government, not all a president-elect or president says can be done independently. In a world where budgets go through the multistep process of checks and balances, I would have focused some funding on identifying illegal drugs coming into the country through the US Postal Service. I would also support legislation to normalize drug testing to be an annual health screening to help identify people who may need treatment starting in adolescents. I would look for expert opinions to predict future trends and recommendations. Last, I would utilize a committee to study these issues in other countries, see how countries with the most successful outcomes handle drug addiction and provide funding to set up pilot programs.

References

The Biden plan to end the opioid crisis. Joe Biden for President: Official Campaign Website. (2020, August 3). Retrieved November 28, 2022, from https://joebiden.com/opioidcrisis/#Links to an external site.

Cunningham, D. (2022, March 2). Biden’s budget would spend $41 billion on drug policy efforts. UPI. Retrieved November 29, 2022, from https://www.upi.com/Top_News/US/2022/03/02/Biden-drug-policy-budget/9461646237606/Links to an external site.

Gomez, A. (2019, January 16). Fact-checking Trump officials: Most drugs enter us through legal ports, not vast, open borders. USA Today. Retrieved November 29, 2022, from https://www.usatoday.com/story/news/politics/2019/01/16/fact-check-mike-pence-donald-trump-drugs-crossing-southern-border-wall/2591279002/Links to an external site.

Souza, S. (2017, May 23). President Trump’s first budget commits significant resources to fight the opioid epidemic – AAAP. American Academy of Addiction Psychiatry. Retrieved November 29, 2022, from https://www.aaap.org/president-trumps-first-budget-commits-significant-resources-fight-opioid-epidemic/Links to an external site.

Use of Postal Service Network to – oversight.gov. (n.d.). Retrieved November 30, 2022, from https://www.oversight.gov/sites/default/files/oig-reports/SAT-AR-18-002.pdfLinks to an external site.

A population health topic that rises to the presidential agenda level is obesity. Effective obesity prevention requires intervening at all levels of society, including the governmental level (Kobes et al., 2022).  According to the American Heart Association (AHA), obesity puts you at an increased risk for many serious health problems, including heart disease, stroke, high blood pressure, high cholesterol, and diabetes.

It is important to educate children on the benefits of an active lifestyle along with a healthy diet (American Heart Association, 2017). If we can change nutritional related behaviors and beliefs among children, we can prevent the cycle of obesity throughout the lifespan (Cook et al., 2017). The education effort must be collaborative among adults, including teachers and parents (Cook et al., 2017). Adult lifestyle behaviors have a direct influence on children’s nutrition patterns (Cook et al., 2017). Several policies and programs have been put into place nationwide to provide nutrition based education and make healthy food options more accessible to all people (Cook et al., 2017). Many school-aged children rely on government programs for their basic nutritional needs (Cook et al., 2017).

Presidents Trump and Biden have both made efforts to encourage lifestyle changes. President Trump’s healthcare vision put American patients, families, and seniors first by providing more choice, better care, and lower costs (The White House, 2015). The Trump Administration took historic actions to lower prescription drug prices, expand access to affordable coverage, deliver hospital and insurer price transparency, and allow Americans to access trusted doctors (The White House, 2015). President Trump guaranteed to always protect people with pre-existing conditions, and he signed legislation to end surprise medical billing after repeatedly calling on Congress to take action (The White House, 2015). Biden pushed for national soda tax. Reducing sugar-sweetened beverage consumption through taxation is a promising public health response to the obesity epidemic in the U.S. (Long et al., 2015). Public health intervention will be required at the policy level to promote healthy behavioral changes in consumers (Frank et al., 2013).

I would implement free educational programs that are available to the community on ways to improve health. For instance, I would do one lecture on how losing a few pounds if you are overweight can improve your health (American Heart Association, 2017). I believe that it is important to provide communities with knowledge, to provide a safe place to ask questions, and to provide resources.

References

American Heart Association. (2017). Keeping a healthy body weight. Retrieved from https://www.heart.org/en/healthy-living/healthy-eating/losing-weight/keeping-a-healthy-body-weightLinks to an external site.

Cook, S., Gerber, S., Heines, K., Martin, C., Reeder, B., Schmidt, S., Sidebottom, E., & Wimsatt, S. (2017) Combating Obesity: Teaching Children to Eat Right. Kentucky Nurse, 65(2), 10-11.

Franck, C., Grandi, S. M., & Eisenberg, M. J. (2013). Agricultural Subsidies and the American Obesity Epidemic. American Journal of Preventive Medicine, 45(3), 327-333. https://doi.org/10.1016/j.amepre.2013.04.010

Kobes, A., Kretschmer, T., & Timmerman, M. (2022). The association between obesity-related legislation in the United States and adolescents’ weight. Health Policy Open, 3(100056-). https://doi.org/10.1016/j.hpopen.2021.100056Links to an external site..

Long, M. W., Gortmaker, S. L., Ward, Z., Resch, S. C., Moodie, M. L., Sacks, G., Swinburn, B. A., Carter, R. C., & Claire Wang, Y. (2015). Cost Effectiveness of a Sugar-Sweetened Beverage Excise Tax in the U.S. American Journal of Preventive Medicine, 49(1), 112-123. https://doi.org/10.1016/j.amepre.2015.03.004Links to an external site.

The White House. (2015). Retrived from https://trumpwhitehouse.archives.gov/issues/healthcare/Links to an external site.

            The COVID-19 conflict is the first major international crisis since the end of the Cold War in which the US has not taken the initiative to respond. For better or worse, virtually every international crisis has seen the US serve as a model for the rest of the world by providing leadership, direction, coordination, and assistance to nations. But this did not take place during the coronavirus crisis. Everyone who is interested in learning about the US reaction to the new coronavirus, or SARS-CoV-2, is aware by this point that there were significant errors in judgment and inaction in January, February, and even March of this year. While errors are unavoidable in the face of such a sizable and swiftly evolving local and global threat, our federal government’s response fell short of many other countries, many of which were already affected by the virus before us. It will take years to fully analyze the faults that led to our poor response, even though we will likely find ways to fix them in the near future.

The president during the Pandemic was Donald Trump who was preoccupied with impeachment at the beginning of that crucial lost month, when his government could have recovered, and he disregarded the harm to the economy and public health. At the month’s conclusion, Trump declared, “It’s going to leave,” indicating that the virus was about to disappear in the US. It will almost suddenly disappear one day. Less than a week before taking office, Biden released a major $1.9 trillion plan that included short-, medium-, and long-term solutions to reduce the current infection and mortality rates and position the US for a long-term recovery from COVID-19 and the economic havoc it has caused.

What I would have done differently was tackle the crisis with all seriousness in the very early stages by getting the vaccines made, which may necessitate invoking the Defense Production Act (DPA), which requires industry to accept and prioritize government contracts in order to ramp up production quickly. I would set an Administration to rely on states to broaden and standardize the categories of people who are eligible for vaccinations, such as all people 65 years and older and front-line workers who are not necessarily medical workers, such as transit, pharmacy, and grocery store employees.

References

https://www.americanprogress.org/issues/security/news/2020/03/26/482274/us-leading-global-response-coronavirus-crisis/Links to an external site.

https://www.brookings.edu/research/the-federal-governments-coronavirus-actions-and-failures-timeline-and-themes/%3fampLinks to an external site.

https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.htmlLinks to an external site.

http://zimmer.csufresno.edu/~johnca/spch100/7-4-agenda.htmlLinks to an external site.

References: 

USA.gov. (n.d.). A-Z index of U.S. government departments and agencies Links to an external site.. Retrieved September 20, 2018, from https://www.usa.gov/federal-agencies/aLinks to an external site.

Meller, A., & Ahmed, H. (2019, August 30). How Big Pharma Reaps Profits While Hurting Everyday Americans. Center for American Progress. https://www.americanprogress.org/article/big-pharma-reaps-profits-hurting-everyday-americans/

NURS:6050 Week 1 Discussion

Mental health consists of psychological, emotional, and social well-being. Mental health determines how people feel, think, and act and determines a person’s ability to relate with other people, handle stress, and make healthy choices. Mental health is needed during childhood, adolescence, and adulthood. However, mental health is different from mental illness. Mental health is as important as physical health because an individual with mental health issues is likely to suffer other physical health complications such as heart disease, stroke, and diabetes. Mental illnesses are prevalent in the United States. For example, over 50% of Americans are diagnosed with mental illness at some point. Similarly, 1 in every 5 American experiences mental illness in a specific area, while one in five children are currently affected by mental illness. One in every 25 Americans lives with severe mental illness like bipolar disorder, schizophrenia, or depression (Centers for Disease Control and Prevention, 2021). Mental illnesses do not have definite causes, but numerous factors contribute. They include early adverse life experiences, experiences linked to chronic conditions like diabetes, use of drugs or alcohol, chemical imbalances or biological factors, and isolation (Centers for Disease Control and Prevention, 2021). Mental illness is an issue that has reached the presidential level and has been handled by two recent presidents.

Management of Mental Health Issues by President Donald Trump and President Joe Biden

The administration of President Trump has been supporting mental health in various ways. One of the remarkable ways is to sign the Law Enforcement Mental Health and Wellness Act into law. President Trump signed the Act into law on January 10th, 2018, after it was passed by the House of Representatives and the Senate. The law is significant to mental health because it has grants that help to fund mental health. The grants also help fund mentorship pilot programs and research focused on determining the impact of Annual mental health checks and crisis hotlines (U.S. Government Publishing Office, 2020). Similarly, Triumph’s administration supported mental health through executive order 13954. Section 1 of this order explains that Trump’sTrump’s administration is committed to preventing suicide tragedies and ending the opioid crisis by improving behavioral and mental health. Section 2 elaborates on the policy to prevent drug-related deaths, suicide, and poor behavioral health outcomes (U.S. Government Publishing Office, 2020). This is crucial because mental health issues increased with the prolonged effect of covid 19.

Similarly, President Joe Biden supports mental health wellness and views it as a bipartisan issue that his administration is committed to serving. President Biden is committed to increasing mental health professionals across the United States and working towards developing an emergency response system with an emergency hotline for mental illnesses. Bi

Biden’s administration also supports mental health and has recently announced two new actions addressing the youth mental health crisis. The initiative helps to understand mental health issues, integrated treatment, and access to healthcare services. Biden announced the awarding of 300 million dollars secured through FY2022 to a bipartisan agreement to expand mental health services across U.S. schools (The White House, 2022). The action was to encourage governors to invest more resources in school-based mental health services.

What I Would do Differently

The two presidents have supported mental health in recommendable ways. Each of them has dedicated a good amount of funds toward mental illness. What I would do differently is to ensure more facilities are built in every state. This ensures that those affected by mental health issues can be admitted into facilities within their locality. It helps to increase social support because family and friends can easily visit the patient because they are within. Similarly, I would increase mental health awareness programs to ensure the community is sensitized about mental health.

References

Centers for Disease Control and Prevention. (2021, November 23). About mental health. https://www.cdc.gov/mentalhealth/learn/index.htm

U.S. Government Publishing Office. (2020). Executive Order 13954—Saving Lives Through Increased Support for Mental- and Behavioral-Health Needs. https://www.govinfo.gov/content/pkg/DCPD-202000758/pdf/DCPD-202000758.pdf

The White House. (2022, July 29). FACT SHEET: Biden-Harris administration announces two new actions to address youth mental health crisis. https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/29/fact-sheet-biden-harris-administration-announces-two-new-actions-to-address-youth-mental-health-crisis/

Presidential Agendas and Health Policies

When thinking about health policies that have risen to the presidential level is the Patient Protection and Affordable Care Act (ACA). As previous President, Barack Obama, established this history-making law in 2010 to address insurance accessibility, rising healthcare costs, and preventative medicine (Affordable Care Act, n.d.). The ACA improved many aspects of the nation’s healthcare and took the uninsured rate from 16.0% in 2010 to 8.9% in 2016 (National Archives and Records Administration, n.d.). The American Hospital Association claims that studies show that people with insurance coverage have better access to care, more positive health outcomes, and are more likely to use appropriate healthcare resources (American Hospital Association, 2022). In 2016 when President Donald Trump came into office, he proposed the American Health Care Act (AHCA) that would shape the Affordable Care Act so that people may choose to obtain health insurance coverage (Obamacare Enrollment, 2021). This law also would have let insurance companies charge more if a person had preexisting or chronic health conditions (Obamacare Enrollment, 2021). The senate did not approve Trump’s proposal (Davalon, 2022). Contradictory of Donald Trump’s original proposition, current President Joe Biden has later restored the ACA to its original form (Luhby, 2021). Knowing how much of an impact preventative medicine and accessibility of health care make, I believe in and would act upon strengthening the ACA to lessen each person’s burdens of their social determinants of health. 

References

     Affordable Care Act. (n.d.). Health Affairs. https://www.healthaffairs.org/topic/4#:~:text=The%20purpose%20of%20the%20ACA,curb%20rising%20health%20care%20costs

     American Hospital Association. (2022). Report: The importance of health coverage. https://www.aha.org/guidesreports/report-importance-health-coverageLinks to an external site..

     Davalon. (2022). Trumpcare (AHCA) vs. Obamacare (ACA). eHealth. https://www.ehealthinsurance.com/resources/affordable-care-act/trumpcare-vs-obamacareLinks to an external site..

     Luhby, T. (2021). Biden signs executive order to reopen Affordable Care Act enrollment. CNN. https://www.cnn.com/2021/01/28/politics/biden-executive-orders-health-care-aca-medicaidLinks to an external site..

     National Archives and Records Administration. (n.d.). Improving health for all Americans. whitehouse.gov. https://obamawhitehouse.archives.gov/the-record/health-care.

Obamacare Enrollment. (2021). Trumpcare vs. Obamacare. Obamacare Enrollment 2022. https://obamacareenrollment.org/trumpcare-vs-obamacare/.

According to Healthy People 2030, approximately 1 in 10 people within the United States do not have health insurance, which significantly limits their access to healthcare services. Access to quality healthcare, is in of itself a social determinant of health (U. S. Department of Health and Human Services, 2022). President Obama addressed this issue directly when he passed the Affordable Care Act in 2010, which provided financial assistance to improve access to healthcare for millions of Americans who previously could not afford health insurance through state and federally funded marketplaces (Patient Protection and Affordable Care Act, 2010). The Affordable Care Act also improved access to healthcare by ensuring that health insurance companies could not deny coverage for individuals who have pre-existing health conditions (Patient Protection and Affordable Care Act, 2010). President Biden also improved access to healthcare for our nation’s veteran population through the Health Care for Burn Pit Veterans Act which became law this year. This legislation improved access to healthcare for veterans who were exposed to toxic burn pit fumes while deployed overseas during the Global War on Terrorism. Prior to this legislation, veterans like myself who were exposed to toxic burn pit fumes had to go through a lengthy process to prove that our health problems were caused by these toxic burn pits. This legislation expanded the list of presumptive positive conditions associated with burn put exposure to include a myriad of health care problems, including a number of different kinds of cancer, and extended VA eligibility periods for these individuals who had previously been denied care under the previous guidelines.

In terms of what I would have done differently, I don’t think I would amend anything regarding the Affordable Care Act. It did have the unintended consequence of increasing health care premiums across the country for many individuals, but I am not sure how this could have been prevented through the legislation. I would, however, have worked to pass legislation improving access for veterans exposed to toxic burn pits a decade ago. Toxic burn pit exposure was a known problem that the VA and the Department of Defense refused to take responsibility for, and as a result many veterans died before they were able to receive any healthcare related to their burn pit exposure. I personally had friends and comrades who died from burn pit associated cancer that the VA denied was service related for years. In my opinion, this was an incredible disservice to our veterans who have sacrificed so much for our country.

References:

H.R.3590 – 111th Congress (2009-2010): Patient Protection and Affordable Care Act. (2010, March 23). https://www.congress.gov/bill/111th-congress/house-bill/3590Links to an external site.

S.3541 – 117th Congress (2021-2022): Health Care for Burn Pit Veterans Act. (2022, February 18). https://www.congress.gov/bill/117th-congress/senate-bill/3541

The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations. (2017). Annual Review of Public Health, 38, 489. https://doi.org/10.1146/annurev-publhealth-031816-044555Links to an external site.

2022. S. Department of Health and Human Services. 2022. Healthy People 2030: Health Care Access and Quality. Retrieved November 30, 2022 from https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality

There are so many different issues in America that are addressed at the presidential level. Some of the issues that America tries to help prevent or reduce are HIV, mental health problems, the opioid epidemic, pandemics, obesity, and prescription drug prices. All these issues are addressed on the presidential level by people trying to correct them. The issue that I want to talk about on a presidential level is opioid drug abuse and how the American president has tried to fix it.

President Biden sent his Administration’s inaugural National Drug Control Strategy to Congress. This was when drug overdose had reached its record high. The goal was to access evidence-based prevention, treatment, recovery, and harm reduction. The plan is to help reduce the drug supply of fentanyl. Biden wanted to treat drug addiction like any other disease. Biden’s plan is to help prevent drug trafficking and stop delivery routes, supply chains, and actions happening on the internet. President Biden wants to beat the overdose epidemic. (President Biden Releases National Drug Control Strategy to Save Lives, Expand Treatment, and Disrupt Trafficking, 2022). In 2018, almost 68,000 Americans died from drug overdoses; of those 68,000 Americans, 47,000 were involved with opioids. Bidens wants to ensure Americans access good quality healthcare, including substance use disorder treatment plans and mental health services in their healthcare. Biden’s plan is to hold the pharmaceutical companies because of their role in the opioid crisis and wants to make recovery services and effective prevention services available.  Biden has invested $125 billion in federal investments toward opioid treatment and helped prevent overprescribing medication while ensuring the needed pain management was available. (The Biden Plan to End the Opioid Crisis, 2022).

President Trump, on March 29, 2017, signed an Executive Order for Combating Drug Addiction and Opioid Crisis. Five meetings were held in 2107 going over the Addiction Policy Forum, young people in recovery, the National Council on Alcoholism, Drug Dependence, Community Anti-Drug Coalitions of America, and Partnership for Drug-Free Kids. (President’s Commission on Opioids, n.d.). President Trump has stated that there are $1.8 billion dollars in grants to prevent people’s lives from being taken by overdose and to help stop the opioid crisis.  There is also another $900 million going toward the research in overdoses for treatment and improving overdose data through the Center for Disease Control and Prevention. During President Trump’s running the country, there had been almost 5,000 pounds of fentanyl stopped along the border in one year. President Trump had 3,000 high areas of drug trafficking stopped, along with money laundering organizations. When President Trump was in office, he provided Americans with education about how dangerous opioid misuse was. He had organizations called  The Office of National Drug Control Policy along with the Truth Initiative partner to educate the youth about the misuse of opioids. By January 2017, there was a 31 percent decrease in the number of opioids that were prescribed. During the first two years President Trump was in office, and there was a 28 percent decrease in the number of veterans on opioids by the Department of Veterans Affairs. There were more efforts in providing supplies of naloxone to help prevent Americans from losing their lives to overdose. Kentucky, New Hampshire, West Virginia, Pennsylvania, and Ohio were most affected by people overdosing. There was a 5% decrease Nationwide in drug overdoses between 2017 and 2018. The drug overdose levels had decreased by 8 percent in West Virginia, 10 percent in New Hampshire, 24 percent in Pennsylvania, 16 percent in Kentucky, and 24 percent in Ohio. There was a decrease in American drug misuse by 11.4 million in 2017 to 10.3 in 2018. (President Donald J. Trump Has Dedicated His Administration to Fighting Back against the Opioid Crisis, 2019).

I agree with what both presidents were trying to achieve by reducing drug overdose to help save American lives. When it comes to educating Americans on drug addiction, there also needs to be more facts about how people will eventually turn to IV drugs to get their fix. Once that happens, the sharing of needles will happen. That is how HIV gets spread and hepatitis. There needs to be more education for Americans on what the effects of misuse of drugs can cause if left untreated. There is more drug abuse in the low-income part of towns because of not having access to proper health care. People need education so they can learn prevention. Their local health departments can help them to get the proper health care. Having more nurse practitioners help with this also. People need to be educated on the resources available in their area to help avoid drug abuse. Both presidents focused more on drug treatment and how they stopped drug trafficking than on prevention. I think more attention should be put on prevention. My local health department provides a nurse practitioner for low-income people. They provide addiction prevention and information on how to get medical insurance. I believe this would help reduce or prevent opioid misuse.

NURS: 6050

Week 1 Discussion

It is almost apparent that every American President faces a crisis at work regarding various issues such as unlawful intimidation, catastrophic events, financial disasters, and political outrage. Some of the issues that have reached the presidential agenda level include controlling and managing infectious diseases. During the tenure of President George W Bush, the issue of HIV/AIDS was rampant. President Bush put much effort into the fight against HIV/AIDS across the world, especially in Africa (Green, 2021). Their efforts are commendable and recognized by both Democrats and Republicans. His efforts stood out among his father’s mixed cultures.

For example, during the reign of senior Bush, he signed two legislations to protect people with HIV-AIDS. One of the policies is the Individuals with Disability Act which ensures that disabled people suffering from HIV AIDS are not secluded. The other Act is Ryan White Comprehensive Aids Assets Emergency Act which helps to offer sick people funds for their treatment. Although the initiative was good and President Bush put much effort, he was still criticized because he declined to sign a policy that would have prevented individuals suffering from HIV AIDS from getting into the nation (Green, 2021).

In addition, he created the President’sPresident’s Emergency Plan for HIV/AIDS Alienation (PEPFAR) for efficiently handling the pestilence. The program was the most popular worldwide and was a satisfactory component of the Bush Administration. Since it started, PEPFAR has used over 80 billion dollars in preventing, treating, and researching HIV/AIDS (Jacobson, 2020). Therefore, it is the most significant global health initiative focusing on a single disease across history. The initiative is popular because it has saved many lives, especially in sub-Saharan Africa.

Shortly after PEPFAR was established in 2003, there was an outbreak of severe acute respiratory syndrome (SARS). The President requested that SARS be added to the infectious disease category that can cause segregation of people. Over 8,000 people were affected by SARS, and around 775 died in 2003 (Roussel et al., 2020).

Similarly, President Barack Obama had to deal with health issues concerning infectious diseases. However, during his tenure, the prevalent infectious diseases were not SARS and HIV but Ebola and Zika. During his reign, an Ebola outbreak killed more than 11,000 people in West Africa (Ostergard Jr, 2020). In July 2014, President of Barack Obama established an emergency operations center to offer specialized help, such as deploying people to West Africa to respond to the situation. The initiative facilitated training more than 25,000 Clinical services personnel in West Africa to help manage and prevent Ebola (Ostergard Jr, 2020).

Like President Bush, President Obama was criticized for not signing the law preventing all infected people from coming to the U.S. President Obama also received a backlash from Republicans for not imposing travel restrictions from nations with Ebola outbreaks. However, only 11 people all over the United States have been treated for Ebola (Ostergard Jr, 2020). His failure to impose travel restrictions did not expose the Americans to significant risks.

Shortly after the struggles with Ebola, Obama also battled with the zika insect that spread the infectious virus. The zika outbreak in 2015 originated in Brazil, and by the end of 2016, around 40,000 cases had been reported across the United States (Grillet et al., 2019). To fight zika, President Obama’s administration allocated 1.9 billion Dollars as an emergency fund. Around $1.1 billion of the budget was ratified by Congress. Another critical initiative during President Obama’s tenure is establishing a health safety and biodefense Unit. The organization’s main aim was to take responsibility for pandemic preparedness (Grillet et al., 2019).

References

Green, A. (2021). A history of US engagement in the HIV/AIDS response. The Lancet, 398(10315), 1956-1957. https://doi.org/10.1016/S0140-6736(21)02540-X

Grillet, M. E., Hernández-Villena, J. V., Llewellyn, M. S., Paniz-Mondolfi, A. E., Tami, A., Vincenti-Gonzalez, M. F., & Alarcón-de Noya, B. (2019). Venezuela’s humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region. The Lancet Infectious Diseases, 19(5), e149-e161.

Jacobson, L. E. (2020). President’s Emergency Plan for AIDS Relief (PEPFAR) Policy Process and the Conversation around HIV/AIDS in the United States. Journal of Development Policy and Practice, 5(2), 149-166.https://doi.org/10.1177/2455133320952210

Ostergard Jr, R. L. (2020). The West Africa Ebola outbreak (2014-2016): a health intelligence failure?. Intelligence and National Security, 35(4), 477-492. https://doi.org/10.1080/02684527.2020.1750136

Roussel, Y., Giraud-Gatineau, A., Jimeno, M. T., Rolain, J. M., Zandotti, C., Colson, P., & Raoult, D. (2020). SARS-CoV-2: fear versus data. International journal of antimicrobial agents, 55(5), 105947. https://doi.org/10.1016/j.ijantimicag.2020.105947

Presidential Agendas

Mental Health Issues

A quarter of adult Americans report experiencing emotional distress or having a mental health disorder like depression or anxiety. People with mental health issues are much more likely to experience various health issues and difficulties, such as substance abuse and chronic diseases like diabetes and heart disease (Milstead & Short, 2019). Spending on healthcare for adults with chronic illnesses and mental health conditions is nearly three times higher than for adults with chronic illnesses only. Generally, Americans have some of the worst outcomes related to mental health, including the highest rate of suicide and the second-highest rate of drug-related deaths among high-income nations.

Social Factors That Impact Mental Health

Age, educational accomplishment, gender, income, place of residence, sexual orientation, and a few more variables have all been linked to mental health. Other social factors, such as family and community dynamics, social support, housing quality, employment opportunities, and working conditions, can have a good or negative impact on mental health outcomes and risk (Milstead & Short, 2019). For example, safe public spaces for social gatherings, such as churches and recreational areas, might be beneficial for mental health. Maintaining and enhancing the mental health of all Americans requires a thorough understanding of these social elements, their effects, and how they interact.

The management of mental health issues by two recent presidents

The year 2018 saw the launch of President Donald Trump’s Law Enforcement Mental Health and Wellness initiative, which provided funding for initiatives for the mentally ill. He also signed a bill creating a national suicide hotline (Conley & Baum, 2022). Additionally, President Trump provided more than $700 million in funding for mental health services and initiatives in 2019. He advocated for treating people with mental health disorders in public and community hospitals (Conley & Baum, 2022). President Trump also prioritized decreasing suicides among veterans, and he issued an executive order urging campaigns to boost public awareness of mental health issues and financing research into suicide prevention.

President Biden, on the other hand, presented the nation’s mental health problems as a problem with broad bipartisan support and unveiled a determined plan to solve them. The plan’s main objectives are to increase system capacity and link those who require assistance to a continuum of care (The White House. 2022). It includes initiatives to increase the number of mental health professionals, work to build an emergency response system to support the launch of the 988-emergency hotline, a focus on children’s mental health, and proposals to pressure insurance companies to improve their behavioral health care coverage. Every health plan will be required by the Biden administration to include comprehensive behavioral healthcare services.

What I would change in the future

The absence of sufficient resources for treating mental health illnesses remains a major concern, notwithstanding the presidents’ various mental health programs. Naturally, this delays patient care. Frequently, people with mental health issues wind up being admitted to facilities outside of their home states without the support of friends or family. Furthermore, many persons who struggle with substance misuse wind up in psychiatric hospitals rather than facilities or programs that cater to their needs (Everett et al., 2019). Therefore, I would make changes by implementing more outreach and mental health treatment programs to increase the accessibility to these services. Additionally, I would guarantee that everyone has access to mental health care and advise states to increase the number of facilities for both substance misuse and mental health treatment.

References

Conley, D. L., & Baum, M. J. (2022). Predictors of structural stigma in state mental health legislation during the Trump administration. Social Work in Mental Health, 36(12), 1-27. https://doi.org/10.1080/15332985.2022.2062272Links to an external site.

Everett, A., Lee-Tauler, S. Y., & Bommersbach, T. (2019). Community and public mental services in the United States. Public Mental Health, 28(09), 417-438. https://doi.org/10.1093/oso/9780190916602.003.0016Links to an external site.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6^th ed.). Jones & Bartlett Learning

The White House. (2022, March 1). FACT SHEET: President Biden to announce strategy to address our national mental health crisis, as part of unity agenda in his First State of the union. Retrieved August 28, 2022, from https://www.whitehouse.gov/briefing-room/ststements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of -the-union/Links to an external site.

Presidential Agendas

Mental Health Issues

A quarter of adult Americans report experiencing emotional distress or having a mental health disorder like depression or anxiety. People with mental health issues are much more likely to experience various health issues and difficulties, such as substance abuse and chronic diseases like diabetes and heart disease (Milstead & Short, 2019). Spending on healthcare for adults with chronic illnesses and mental health conditions is nearly three times higher than for adults with chronic illnesses only. Generally, Americans have some of the worst outcomes related to mental health, including the highest rate of suicide and the second-highest rate of drug-related deaths among high-income nations.

Social Factors That Impact Mental Health

Age, educational accomplishment, gender, income, place of residence, sexual orientation, and a few more variables have all been linked to mental health. Other social factors, such as family and community dynamics, social support, housing quality, employment opportunities, and working conditions, can have a good or negative impact on mental health outcomes and risk (Milstead & Short, 2019). For example, safe public spaces for social gatherings, such as churches and recreational areas, might be beneficial for mental health. Maintaining and enhancing the mental health of all Americans requires a thorough understanding of these social elements, their effects, and how they interact.

The management of mental health issues by two recent presidents

The year 2018 saw the launch of President Donald Trump’s Law Enforcement Mental Health and Wellness initiative, which provided funding for initiatives for the mentally ill. He also signed a bill creating a national suicide hotline (Conley & Baum, 2022). Additionally, President Trump provided more than $700 million in funding for mental health services and initiatives in 2019. He advocated for treating people with mental health disorders in public and community hospitals (Conley & Baum, 2022). President Trump also prioritized decreasing suicides among veterans, and he issued an executive order urging campaigns to boost public awareness of mental health issues and financing research into suicide prevention.

President Biden, on the other hand, presented the nation’s mental health problems as a problem with broad bipartisan support and unveiled a determined plan to solve them. The plan’s main objectives are to increase system capacity and link those who require assistance to a continuum of care (The White House. 2022). It includes initiatives to increase the number of mental health professionals, work to build an emergency response system to support the launch of the 988-emergency hotline, a focus on children’s mental health, and proposals to pressure insurance companies to improve their behavioral health care coverage. Every health plan will be required by the Biden administration to include comprehensive behavioral healthcare services.

What I would change in the future

The absence of sufficient resources for treating mental health illnesses remains a major concern, notwithstanding the presidents’ various mental health programs. Naturally, this delays patient care. Frequently, people with mental health issues wind up being admitted to facilities outside of their home states without the support of friends or family. Furthermore, many persons who struggle with substance misuse wind up in psychiatric hospitals rather than facilities or programs that cater to their needs (Everett et al., 2019). Therefore, I would make changes by implementing more outreach and mental health treatment programs to increase the accessibility to these services. Additionally, I would guarantee that everyone has access to mental health care and advise states to increase the number of facilities for both substance misuse and mental health treatment.

References

Conley, D. L., & Baum, M. J. (2022). Predictors of structural stigma in state mental health legislation during the Trump administration. Social Work in Mental Health, 36(12), 1-27. https://doi.org/10.1080/15332985.2022.2062272Links to an external site.

Everett, A., Lee-Tauler, S. Y., & Bommersbach, T. (2019). Community and public mental services in the United States. Public Mental Health, 28(09), 417-438. https://doi.org/10.1093/oso/9780190916602.003.0016Links to an external site.

The  White House. (2022, March 1). FACT SHEET: President Biden to announce strategy to address our national mental health crisis, as part of unity agenda in his First State of the union. Retrieved August 28, 2022, from https://www.whitehouse.gov/briefing-room/ststements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of -the-union/Links to an external site.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6^th ed.). Jones & Bartlett Learning.

Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently?

I live in New Mexico, and while there are many population health topics I could discuss, the opioid epidemic is truly rampant here. With the cartels sending it over the border in droves, our local news has reported that we have seen a 900% increase in Fentanyl alone our state over the last few years. According to (Murray, 2019), “Millions of Americans are impacted by the opioid crises.” People are dying at alarming rates due to opioid overdoses. Drug abuse has crippled our neighborhoods and communities for decades and continues to be on the rise.” The opioid epidemic has so many crucial impacts that it is a significant population health issue that will continue to rise to the presidential agenda level with each new president. With growth rates of 900% in some areas of the United States and no signs of slowing down, it is easy to see why. Education, poverty, and mental health are all social determinants of health that have factored into the opioid epidemic.

President Obama signed the very first Bipartisan bill that addressed the opioid epidemic. On July 22, President Barrack Obama signed the Comprehensive Addiction and Recovery Act, the first of its kind to offer a multifaceted federal response to the prescription opioid and heroin epidemic ravaging communities across the United States (Reilly, 2016). The purpose of this bill was to combat the misuse of opioids and ensure that people have access to effective treatment.

According to (Ending America’s Opioid Crises, The White House) “President Trump’s Initiative to Stop Opioid Abuse, unveiled in 2018, confronting the driving forces behind the opioid crises”. President Trump saw education as a critical piece of addressing the opioid problem and allocated funds to support education efforts. Next, he wanted to address how the drugs were coming into the U.S. he believed that building the wall between the U.S. and Mexico would help decrease drugs crossing the border. Finally, President Trump pushed for more treatment centers to address the growing number of Americans who had become addicted and were seeking help.

As opioid addiction has continued to grow and become a more pronounced issue that many Americans face, I am thankful for the support our Presidents have shown in trying to address it. I believe there is more we can do, starting with mental health. We continue to see a link between drug use and mental health. I genuinely believe it is time to dedicate suitable funds and resources to help address the opioid problem from a mental health standpoint: more treatment options and facilities and more coverage for patients seeking treatment.

                                                                                                               References

Murray, K. (2019).Racial Disparities in Opioid Addiction Treatment in Black and White Populations. Retrieved June 1, 2020, from https.//www.addictioncenter.com/news/2019/10/racial-disparities-opioid-addiction-treatment/

Ending America’s Opioid Crises|The White House,(2020). The White House. Retrieved June 1, 2020, from https://www.whitehouse.gov/opioids/

Reilly, K., (2016). President Obama Signs Bipartisan Bill to Combat Opioid Epidemic. Retrieved on June 1, 2020, from https://www.pewtrusts.org/en/research-and-analysis/articles/2016/07/22/president-obama-signs-bipartisan-bill-to-combat-opioid-epedimic

Prescription drug costs are astronomical and rob Americans of the ability to maintain health. The cost of prescriptions continues to skyrocket, and people’s health continues to decline. Overuse of the emergency room due to inability to afford medications. The cost of healthcare as a whole continues to increase and one way to correct this is to get patients preventative and maintenance care before an acute exacerbation of chronic illness.

Trump and Biden have made attempts to address this issue, although the proposal will likely not help. Healthcare is just simply not affordable. (Meller & Ahmed, 2019) Biden believes an affordable help care act could reduce the cost of healthcare. This act will allow Americans to obtain affordable health care. While health care may be more affordable the quality will be worse. (Office, 2022) The cost of drugs is driven by the gain from drug companies. Big Pharma will not let its profit margin suffer; therefore, the cost will forever be escalating. (Meller & Ahmed, 2019) Biden has an agenda to continue to address this issue, but nothing as of now has been effective and we are still at a standstill. (House, 2022)

I am not certain there is a solution or a way I would handle it better. The structure of health care is not benefiting the providers or patients. We hand out a lot of free healthcare and we practice liability medicine due to providers’ fear of being sued. The problem in health care is we do too much. If I were to fix the problem, I would shave off over half the health care we provide. Million-dollar work ups in the ER over and over again drives the costs up. I would reduce the use of medical resources and only order what is necessary for patients.

Resources

Office, A. P. (2022, September 29). Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023. HHS.gov. https://www.hhs.gov/about/news/2022/09/29/biden-harris-administration-announces-lower-premiums-for-medicare-advantage-and-prescription-drug-plans-in-2023.htmlLinks to an external site.

‌Meller, A., & Ahmed, H. (2019, August 30). How Big Pharma Reaps Profits While Hurting Everyday Americans. Center for American Progress. https://www.americanprogress.org/article/big-pharma-reaps-profits-hurting-everyday-americans/Links to an external site.

‌House, T. W. (2022, October 14). Executive Order on Lowering Prescription Drug Costs for Americans. The White House. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/10/14/executive-order-on-lowering-prescription-drug-costs-for-americans/

One thing I have noticed throughout my career as a nurse is how difficult our healthcare system is to navigate. Even for nurses working within their own healthcare system, maximizing what they can get for their patients is difficult. Without assigning responsibility for this, it is easy to see why your average joe has issues doing everything that is asked of them by healthcare professionals. As a nurse that works in home health, I am provided with a unique perspective of just how poorly healthcare facilities do with discharging and educating patients to succeed in the home environment. This isn’t the facilities’ faults, but the fact is if we were able to improve that portion of the process, I think we would see huge improvement in patient outcomes. One huge issue facing providers trying to do right by their patients is the price of prescription drugs and how they vary depending on the patient’s coverage. This issue results in different people paying outrageous prices for medications while others pay nothing. As a home health nurse, there have been numerous times I have been forced to help a patient budget what medications they can take instead of taking them as ordered.

One thing President Trump did to address this concern was met with some controversy but was aimed at reducing drug costs across the board. He signed an executive order on September 13, 2020 with the aim at aligning our drug prices with the best offered across the globe (Mulaney, 2020). While this sounds good on paper, it wasn’t successful and not held up in courts. I believe part of the reason for it’s lack of success was related to the added costs our country incurs related to all the testing we conduct. A drug might cost cheaper elsewhere, but it also might not test to the point that it is as safe as drugs we manufacture and distribute.

Current President Biden’s approach was more direct and has me feeling more optimistic. In October, Biden announced the plan to allow Medicare to negotiate directly with pharmaceutical companies for the first time and cap the out-of-pocket expenses for those on medicare at $2,000 a year (Whitehouse.gov, 2022). This has me excited because a lot of people are paying over that in co pays yearly, often for one medication. An example of this that I personally experienced when I was prescribed Xarelto, my insurance wanted me to pay $500. Luckily, I was able to apply for a program through the manufacturer to get that largely discounted, but last time I checked that program wasn’t available for those on Medicaid and medicare. I often have patients who thought they had great coverage end up paying close to what I did for their Xarelto, and they can’t get it discounted due to their status. If I were President I would make sure that everyone has the same prices for medications universally. I also would make sure that people didn’t lose insurance coverage if they were unemployed. Hopefully that would help our most vulnerable populations.

President Trump Signs Executive Order on prescription drug pricing. AAMC. (2020, September 18). Retrieved November 30, 2022, from https://www.aamc.org/advocacy-policy/washington-highlights/president-trump-signs-executive-order-prescription-drug-pricing

The United States Government. (2022, October 14). Fact sheet: President Biden takes action to lower health care and prescription drug costs for Americans. The White House. Retrieved November 30, 2022, from https://www.whitehouse.gov/briefing-room/statements-releases/2022/10/14/fact-sheet-president-biden-takes-action-to-lower-health-care-and-prescription-drug-costs-for-americans/